Guidelines for Cardiac Rehabilitation Programs, 2d ed.

American Association of Cardiovascular and Pulmonary Rehabilitation. Champaign, IL 61825-5076, Human Kinetics Inc, 1995, paperback, 155 pp, illus, $30.

The purpose of this publication is to present a nationally derived consensus statement of guidelines applying to cardiac rehabilitation programs that have been developed by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). This second edition reviews current research and practice models and is a summary of minimal guidelines for excellence in cardiac rehabilitation to be used in new and existing programs. The committee that formulated these competencies includes health care professionals from a variety of disciplines.

The first chapter consists of an overview of cardiac rehabilitation by defining the phases of recovery; an outline of administrative concerns; and the establishment of minimal guidelines for documentation, personnel, and patient rights. Chapter 2 describes inpatient and outpatient program structures including components, appropriate candidates for services, guidelines for monitoring patients, and factors that determine the length of a program. Chapters 3 and 4 are devoted to evaluation, treatment implementation, and assessing outcomes for cardiac rehabilitation. Chapter 3 summarizes the rationale and safe administration of graded exercise testing, the formulation of appropriate exercise prescriptions, and the incorporation of resistance training to augment conventional aerobic training. An addition to this second edition is a discussion of the modification of these activities for the elderly participant. Chapter 4 includes recommendations for content areas and for design of the patient education component, assessment and intervention of the psychosocial aspect of cardiac illness and recovery, and suggestions for measurement and evaluation of outcomes for the individual and for the overall program.

The remaining chapters focus on the administrative aspect of cardiac rehabilitation. Chapter 5 discusses personnel issues including suggested staffing and minimal qualifications to provide optimal care for all levels of cardiac rehabilitation. Discretion has been taken by the AACVPR not to recommend duties to be performed by specific disciplines, with the exception of a licensed physician for medical and program consultation. The document "Core Competencies for Cardiac Rehabilitation Professionals" developed by the AACVPR is presented in Appendix A as a supplement to this chapter. Chapter 6 deals with general guidelines for the medical record with the intent to encourage uniform and consistent documentation for evaluation, intervention, and outcome measurement.

Chapter 7 reviews management of emergency situations including requirements and recommendations for staff training, warning signs and symptoms of impending emergencies, policies and procedures for implementation of the emergency plan, and a list of emergency equipment. Sample forms are provided in Appendix B for documentation, informed consent, and emergency procedures that expand on chapters 6 and 7. The final chapter specifies the facilities and equipment required for inpatient and outpatient cardiac rehabilitation programs and for graded exercise testing.

Overall, this textbook fulfills its purpose of presenting the AACVPR core competencies and the guidelines with which to meet these competencies. It represents a consensus of philosophy for cardiac rehabilitation without regard to turf issues associated with individual disciplines. developing and existing cardiac rehabilitation programs will find this text useful as a basis for comparison with AACVPR standards. What the text does for compromise, however, it sacrifices for in substance and the authors acknowledge this shortcoming. They recognize that it is not meant to be all-inclusive in its presentation of guidelines and, therefore, should not be the only reference for cardiac rehabilitation programs. The generalized guidelines and lack of specific instructions will limit its use to a supplemental resource for multidisciplinary practitioners and students.

The text is well organized and is easy to read, with the minimal guidelines developed by the AACVPR highlighted throughout for easy reference. Bibliographies at the end of each chapter are up-to-date, but not extensive. The second edition expands the previously underserved areas of endurance training, psychosocial issues, and outcome measures. In summary, this book represents a significant collaborative effort among health care professionals to develop standards of care for cardiac rehabilitation based on current knowledge and practice.

Nancy B Schuster, PT Mercy Hospital Portland, Me

Ms Schuster is the senior inpatient physical therapist at Mercy Hospital, and she serves as an adjunct instructor to physical therapist students and physical therapist assistant students in the area of cardiopulmonary physical therapy.